Heartbeat: risk of stroke in patients with heart failure

In patients with heart failure (HF), the increased risk of ischaemic stroke often is attributed to coexisting atrial fibrillation (AF). To test the hypothesis that there is a higher risk of ischaemic stroke in patients with HF, even in the absence of AF, Chou and colleagues1 used data from the Taiwan National Health Insurance programme. Over 12 000 patients with newly diagnosed HF were matched by propensity score to the same number of patients without HF, after excluding patients with AF or atrial flutter at baseline or during the follow-up period, as well as patients with previous stroke or acute myocardial infarction. The risk of stroke over a mean follow-up of about 6 years in those with HF was higher than in those without HF (subdistribution HR (SHR)=1.51, 95% CI: 1.37 to 1.66). There also was a higher cumulative risk of stroke and acute myocardial infarction in those with HF (figure 1). In those with HF, multivariable risk factors for stroke were older age, male sex, diabetes and hypertension. These data support the author’s hypothesis that HF itself is associated with a higher risk of stroke in the absence of AF. Figure 1 Cumulative incidence of ischaemic stroke (A) and acute myocardial infarction (B) in individuals with HF or without HF by propensity score matching. HF, heart failure. In an editorial, Nelson and …